Buttertea at Sunrise Page 6

  Between every bit of revealed information, Lhamo’s mother asks me if I can fix her daughter. Gently, I tell her that I will try my best. Mom is not satisfied. In her eyes I am a foreign doctor, therefore ordained with a lot of knowledge and ability. I have to cure her daughter.

  I ask Pema to coax some answers out of Lhamo, but the girl only stares at us. Her look is frightened and distrustful. Without touching her, I again start speaking to her in English, and Pema translates. I explain that I only want to have a look, that I will not hurt her, that her mom will stay right beside her the entire time, and that she can tell me where she has pain. Ever so slowly, Lhamo relaxes. Still suspicious, she watches my every move, but at least her distrustful attitude slackens.

  A few spectators have gathered in the hallway and this time, determined to get some privacy, I shut the windows and door tightly. Then I ask Lhamo to remove her skirt, a simple flowered petticoat that she wears instead of her kira. Lhamo refuses. I try to explain that I have to look at her whole leg—but she is immoveable. Tentatively, I lift the flimsy garment a few inches, and Lhamo starts wincing like a baby. I realize the problem immediately. Lhamo has no underwear.

  Somehow we manage to tuck her skirt between her legs to cover her embarrassment and still allow me a better look. The back of her right leg is horribly deformed. A long, deep, and tight burn scar covers the rear of the knee and stretches in ropelike bands all the way up to her buttock. Though not painful, it resists all effort to straighten it beyond a seventy-five-degree bend. The right foot hangs on the ankle like a useless appendage. All muscles have been wasted from years of disuse, and her sole is turned in, resembling what is medically termed a clubfoot. Although she is tense and tries to resist my moving her leg, Lhamo is far too weak to put up a real fight. Instead, she continues whining and whimpering, yet whenever I ask if there is pain, she shakes her head.

  Her other knee is obviously very tender. The moment I touch it, Lhamo starts screaming. After several attempts, I have to give up. I assume, from what I observe, that there is maybe a five-degree freedom of movement, if any. We ask Lhamo’s mother if the knee has always been this stiff, and she confirms. Has it always been this painful? She nods.

  Neither her mother nor Lhamo have told me about any other injuries, but in her chart I see a note about dressing a bedsore, so I continue my examination. I find not one but two deep, puss-filled sores, one over her tailbone, and one over her left seat bone, which explains why Lhamo does not want to sit. Thin cotton bandages have been taped over the wounds, but with her moving about, they have slipped, and now the tape is partly stuck to the bleeding flesh. The wounds are oozing, and Lhamo’s skirt is damp. Appalled, I ask her mother when these wounds were last cleaned.

  “Yesterday.”

  “Why not today?” I ask, wondering who is responsible for this needless neglect.

  “Always, they are only done every two days,” Pema answers.

  I am shocked. “Do they always look like this?”

  The answer is yes. From Pema’s translation, I learn that it is difficult for Lhamo to use the toilet and that the bandages always get wet from washing her buttock after passing stool. Still Lhamo’s mother thinks that they are slowly getting better.

  Lhamo is quietly whining to herself, and when I turn to ask her to sit up, she throws a temper tantrum and screeches in a high-pitched voice. Her mother chides her sternly, but Lhamo continues her lamenting. Pain and an overwhelming terror are clearly written on the girl’s face. I understand that for today it is enough and ask her mother to take Lhamo back to the ward. Relieved, the tiny mother picks up her daughter and carefully carries her out of the physiotherapy room.

  I feel guilty. Did I push Lhamo too hard? Desperate to focus on something positive, Pema and I discuss the availability of wheelchairs. There are three new ones in the hospital, one of which belongs to physiotherapy and two to the wards. Unfortunately, the physiotherapy chair always disappears. I ask Pema to go and look for it, and she dutifully sets off on her mission. Minutes later she returns with a foldable, soft plastic-seated wheelchair, and I sigh in relief. At least one thing we can offer to Lhamo immediately.

  A quick check of the chair reveals that the brakes are useless, overstretched and barely able to touch the wheels. For the umpteenth time since my arrival in Bhutan, I pull out my Swiss Army knife and start repairing. Luckily, the problem is easy to fix, and I take the chair for a test ride.

  Although I generally find the faces of the people here very hard to read, as I wheel myself past the windows of the operating theatre’s prep room the nurses’ astonishment is obvious.

  “Sister Britta! Where are you going?” Sister Rupali, a plump, jovial nurse sticks her head out the window and calls after me. In the hospital, I have been demoted from doctor to sister.

  “Just testing out the chair!” I reply and grin.

  “Sister, will you come for tea? Please come and join us for tea. Sister Pema is always coming for tea!”

  I have wondered when and if we get a lunch break, and the offer is tempting.

  “Thank you. I would like that.”

  The window of the OT prep room closes again, and I steer back to my treatment room.

  Over a hot cup of sweet tea, perfectly spiced with ground cardamom and cloves, and a couple of sugary cookies, I voice my worry about Lhamo’s wound dressing.

  “Do you think it could be done more regularly?”

  “Lhamo is nice girl, isn’t it,” Sister Chandra replies. “It is good that you can help her now.”

  Sister Rupali agrees but also dodges the issue of wound dressing.

  “You have to talk to Matron about that, sister. Here in the OT, we only prepare the dressing sets. You see,” Sister Rupali points to the steaming autoclave, “it is so difficult. No electricity and it is always broken, isn’t it, sister?”This time she turns to the other OT nurses for confirmation. Everyone at the table nods seriously. “Every day we make dressing kits, we are always busy. But this machine is never working.” Rupali condemns the whistling autoclave with another stare. Then abruptly she changes the topic to yesterday’s operation.

  Most of the nurses at Mongar Hospital seem to come from Southern Bhutan, and among themselves, they generally speak Nepali. Initially, I guess that the discussion centres on an emergency caesarian section, but then I get lost in the foreign language and cannot follow another word. Surrounded by eagerly chatting nurses, I am left sipping on my tea, wondering how long it will take me to understand at least enough of my colleagues’ language to participate in their daily gossip.

  After my interlude in the OT’s prep room, Pema and I take the prized wheelchair to the ward. It is time to teach Lhamo that from now on, at least while she is in the hospital, there will be an alternative mode of transportation to her mother’s back.

  We find both Lhamo and her mother on the bed sharing lunch. Excited talking erupts at our arrival, and the half-empty plate of food is left on the blanket. While I push the wheelchair over to the bed, I take a look at the hospital ration. Rice, some sort of potato curry, and a cup of dal comprise the lunchtime feast. Earlier I saw how the cook dished it out from a couple of huge buckets in the courtyard, but now I am somehow surprised to see it here, heaped on a plate. It looks better than I had anticipated.

  Lhamo eyes the wheelchair with a worried face. All new commodities cannot be trusted, and the unknown technology seems to intimidate my young patient. The little chattery mother, however, is quick to realize the advantages of mechanical wheels. With a beaming smile, she proudly assesses the chair.

  Still looking more than skeptical, Lhamo eventually lets herself be convinced to give it a try. To avoid further complications, I decide to neglect the proper rules of a transfer for the moment and lift Lhamo off the bed. Mistake! Within fractions of a second, her long skinny fingers dig into my neck, and she lets out a terrified squeal. Like a monkey, she hangs on for dear life, refusing to let go of my neck. I can hear Pema talking and even the neig
hbouring patients giving good advice, but only the warning voice of her mother makes Lhamo relax her grip. Slowly, we lower her onto the chair, and she sits awkwardly and stares at me. Determined, her mother takes the steering and starts wheeling Lhamo around the ward.

  When she finally comprehends the great potential of her newfound freedom, Lhamo’s face brightens into a lovely smile. Carefully, she leans over the sides, testing the armrests with a tentative pressure and playing with the foot supports.

  “Yalama!” she calls out in excitement, and an old woman in the bed beside her starts cheering.

  Now eagerly jabbering with her mother, Lhamo propels the wheels forward a few feet, then she claps her hands and turns around to look at us. Her face is radiant with joy. In her eyes shimmer hope and excitement and childish pleasure in the little perks that must come along so rarely. As if waiting for this moment for many months, Lhamo’s laughter breaks through her wall of suffering. No longer confined to her bed, on the plastic seat of an overstretched wheelchair, Lhamo has found a new independence. And for the first time since my arrival in Mongar, I know that I made the right choice in coming here.

  7

  back-breaking work

  The end of my first week in Mongar is drawing near, and this dark and rainy morning promised to be slow. Feeling slightly more at ease with my new routine, I left the hospital for a few minutes to get some of my textbooks from the house. Heavily loaded, I now walk back past the OT. There is a lineup in front of our physio windows. When I left, the hallway was deserted, but now it looks as if someone has opened the floodgates. I observe the queue but cannot recognize any of the faces. Moreover, this crowd is not like the usual onlookers; they seem to be patiently waiting for me, absorbed in their own thoughts.

  As I approach, the line divides respectfully to let me through. Perhaps my white lab coat is an unmistakable sign of authority. I smile at the patients and notice that most of them are dressed in Indian clothes, the women in saris and the men in simple shirts and trousers. I wonder if they are workers on the hospital construction site, or else road workers whom I have seen in little camps all along the road from Thimphu to Mongar.

  Pema is already busy taking a history. Since I cannot hear any ngamla (“pain”) or oga? (“where?”), the words must not be Sharchhopkha, and I assume that Pema is talking in Nepali or Hindi. Not comprehending a word, I sit down to watch. The woman beside Pema speaks in a low, almost inaudible voice, her hands neatly clasped and folded on her lap. Her concern seems urgent and somewhat confidential. She never looks at me, but after a while, Pema translates.

  The patient’s name is Dhan Maya, and she is indeed a road worker at a site about an hour’s walk from here. Her job consists of carrying stones to a spot where others can break them. For the last few weeks she has been suffering from back pain, and now she can no longer sleep at night.

  I look at her referral. It says “Chronic lumbar derangement. For physiotherapy. Kindly assess and treat.” The signature is a big, bold B with a few scribbles behind it. I ask Dhan Maya about her doctor. She says it is Dr. Bikul, the young Indian doctor working in Outpatients.

  Pema and I complete the assessment together. Sadly, I realize that there is precious little I can do for this lady. Made of only skin and bones, Dhan Maya’s stature is far too fragile for her heavy labour, and other than somehow altering the gruelling tasks of her day, nothing will alleviate her agony. I discuss her options with Pema. A new job is out of the question. She is here with her family from Bengal, and she and her husband work in order to make some money to send home to his siblings. They are grateful for the work; they have been here for almost seven years.

  I ask about decreasing her hours but I get only a small shake of the head as an answer. I ask if she can take a few more breaks during the day, but again the answer is a no. I ask if it is possible for her to switch her duties with another woman, but she says that they are all doing similar things, and anyway, she is one of the youngest and strongest.

  Can she come here for treatments?

  No, it takes too much time out of her work. She has only this morning off.

  Physiotherapy is not a profession that counts on quick fixes and easy cures, and I am used to running into problems. However, here in Bhutan, I face new challenges. At home, I would call her employer and discuss light duties or a change of duties. She could get worker’s compensation or, at the very least, she could get some time off. There would be some way to lessen the constantly aggravating circumstances—but here? What should I tell her? I feel dreadful. I am facing a dead end and I know it.

  I am stuck for advice, or a treatment, but somehow it becomes clear that my shy, polite patient is not really expecting any. She is already halfway out the door and apologetically explains that she has to leave. She needs to get back to work now.

  “We see many workers here,” Pema sighs, her eyes full of sympathy. “You have seen where they live?”

  I nod.

  “You will be able to treat them?”

  “I hope so,” I reply without admitting my doubts.

  The next few patients all have similar complaints. Low back pain, shoulder pain, elbow pain. Every time it becomes disturbingly obvious that the symptoms are caused by the brutal physical nature of their work. They are all labourers. They all need their jobs. None of them can afford to take time off, and none of them wants to. They walk in with clothes soggy from the rain, tired, dragging their feet, and they leave much the same way—disillusioned, resigned, accepting.

  I feel miserable and useless. I wish that we could at least offer them a rest under the heat lamp, something to comfort them for a short time, but there is no electricity today, and our desired machines are hiding in the damp semidarkness of the room.

  At last, I am confronted with an acute, treatable condition. Pasang, a young Bhutanese man of twenty-seven, hurt his back while lifting a log. I ask him to rest for the day and teach him some exercises. My confidence is boosted, and my spirits rise. Though he is one out of many, at least he can benefit from my being here.

  Pema asks why he differs from the other patients we have assessed so far, and we take the time to discuss his condition in more detail. I want this to be a learning experience for Pema. Finally, I send Pasang back to the doctor to ask for a prescription for some anti-inflammatories. Within a few minutes, he returns. The doctor wants to speak to me immediately.

  I am not even surprised. All of the outpatient referrals today have come from Dr. Bikul, and this is the first one I have actually been able to treat. Now Dr. Bikul is questioning my methods.

  Already this morning during rounds, I had a run in with him over the diagnosis of one of his patients. He thought it was a case of L3 (lumbar vertebrae 3) paraplegia. To me it looked more like an incomplete L4, and I voiced my opinion. We argued for a while over whether it could be caused by a tumour, an autoimmune disorder, or a compression fracture. Then he tested me on the nerve supply of the entire lower extremity, all the while waiting for me to foul up. I did not falter. I stood my ground and demonstrated my knowledge. He seemed astonished. Finally, he admitted that he knew next to nothing about physiotherapy and abruptly turned back to his patient.

  Now he probably wants to grill me again. Well, he can wait. There is another patient outside who has been expecting to see a physio for almost an hour. I will finish here first and then go. After all, if it is so urgent, why can the good doctor not come here himself? With a sweet smile, I ask Pasang to go back and let Dr. Bikul know that I will come soon.

  The harvesting of grain has always been a back-breaking labour.

  Half an hour later, Pema and I enter Chamber No. 4 behind a thick, blue curtain. Dr. Bikul looks up from his papers. “Please sit,” he says and directs us to two chairs facing his desk. His attitude is distant, and his arrogant expression gets under my skin. Defensively, I square my shoulders and then look at Pema for reassurance. As always, she is smiling.

  “You wanted to talk to me?” A little bout o
f panic wells up in me, but I try not to let it show.

  “Yes.”

  The foreboding silence that follows evaporates my earlier courage. I cannot read his expression. Maybe I did do something wrong. Again I look at Pema, but she does not seem perturbed. In my mind, I quickly run through the cases that I have seen this morning. What does he want from me?

  His question pulls me out of my thoughts. “How do you like Mongar?” For the first time, a tiny shadow of a smile whisks across his face.

  “Well, I am not sure yet,” I stutter. Then I quickly add, “It seems like a nice place.” Quietly, I scold myself for not displaying more enthusiasm.

  “I am sorry that I sent you so many patients this morning. I did not know if physiotherapy could do something for them, but I thought you would try.” He seems almost sincerely apologetic. More relaxed now, I wait for what is to come.

  “Could you explain to me why you gave Pasang those exercises?”

  Here is my trap. Again I feel my body stiffening, but then I remember that he is the one who knows nothing about physiotherapy.

  “From my examination I found that Pasang has a mechanical low back problem.” I launch into a long explanation of mechanical back pain, its causes and applicable physiotherapy treatments.

  Dr. Bikul listens attentively. At one point, I feel like I am convincing myself and not him. How do I explain the other mechanical back pain patients to whom we did not teach any exercises? Will he take offence if I talk about the back-breaking working conditions of the labourers? This is only my first week here; better not to stir up any trouble.

  Dr. Bikul is still occupied with Pasang and calls him back into the room.